Are you considering buying a standalone critical illness policy? Here are some inclusions and exclusions you should be aware of.
Conditions like cancer, sclerosis, coma, cardiac arrests, paralyses, kidney failure, etc. are expensive to treat and impact the lifestyle after hospitalisation.
The health insurance companies understand the severe nature of these diseases which are difficult to survive with and categorise them as critical illness.
The critical illness plan devised by the insurance companies try to cover medical as well as other expenses which arise after the diagnosis. It thus provides with a lump sum benefit which can provide financial help at the time of crises.
You can thus save yourself from breaking your mutual funds and fixed deposits or in some scenarios borrowing or raising funds. Your life’s savings are also saved from getting wiped out.
However, in order to make a wiser decision while buying a plan you need to understand the technical implications of the fine print of these policies. You should know about the inclusions and exclusions as it can help you when the need arises.
So, here’s a gist of inclusions and exclusions in a standalone critical illness policy-
Inclusions
In general, a standalone critical illness plan will have a list of ailments with a definition which specifies the type and severity. It is essential that you thus refer to not only the number of ailments but also the definitions underlined to understand the coverage offered in the plan. Common list of conditions covered under a critical illness plan are:
- Cancers, which are of a specified severity
- First cardiac arrest or heart attack of a specified severity
- Open chest CABG
- Open heart replacement/repair of heart valves
- Coma of a specified severity
- Kidney failure which needs regular dialysis
- Stroke resulting in permanent disability or issues
- Major organ/bone marrow transplant
- Permanent paralysis of limbs
- Motor neurone disease with permanent symptoms
- Multiple sclerosis persisting symptoms
- Aplastic anaemia
- Bacterial meningitis
- Loss of speech
- End stage liver disease
- Deafness
- End-stage lung disease
- Fulminant viral hepatitis
- Major burns
- Muscular dystrophy
This list differs as per your insurance company. Hence, read the policy terms and conditions to understand the scope of cover of your plan.
Exclusions
- Critical illnesses, for which you are diagnosed within first 90 days from your policy start date
- Death within 30 days of diagnosis of critical illness or surgery
- Illnesses caused due to smoking, tobacco, alcohol or drug intake
- Diseases that occur because of internal or external congenital disorder
- Critical conditions or severe side effects of pregnancy or childbirth, including caesarian birth
- HIV/AIDS infection
- Dental care or cosmetic surgery
- Infertility treatment
- Hormone replacement treatment
- Treatments outside India
- Treatments to assist reproduction
Advantages of the Critical Illness Insurance Policy
Critical illness insurance policies safeguard you against financial vagaries. It will cover you and your family from high medical expenses. The policyholder is entitled to a lump sum amount if diagnosed with any illnesses covered by your policy. You would also get a reimbursement for your cost of care and recuperation aid. You are also entitled to tax benefits under Section 80D. Post hospitalisation benefits like free health check-ups are provided as well.
Who Should Buy the Critical Illness Insurance Coverage?
Consider the following cases of cancer:
- Herceptin (the breast cancer drug) may cost you anywhere between Rs. 75,000/ vial and Rs. 1 lakh /vial. A patient will need at least 16 vials as treatment.
- Angioplasty can cost anywhere between Rs. 1 lakh and Rs. 3.5 lakhs.
In both the cases, having a critical illness plan seems to be a viable option. Anyone with a remote family history of critical illnesses should opt for this coverage. Particularly, the breadwinner or the sole earning member should avail of it.
As per research data by National Crime Records Bureau, 26,426 Indians suffered from chronic ailments in 2013. These include AIDS, cancer and paralysis. Thus, having a valid critical illness cover comes both as a standalone insurance plan and as a rider on a health insurance plan is essential more than ever.